With notable consistency across clinical trials, Enhanced Cognitive Behavioral Therapy (CBT-E) has been shown to be the most effective outpatient treatment for eating disorders in adults. Last week’s blog post provided details about the treatment and what you could expect from each stage in the process.
CBT-E is a time-limited, individual psychotherapy where clients work one-on-one with their CBT therapist to break destructive patterns and improve their relationship with food and their bodies.
CBT-E is designed to treat the full range of eating disorder behaviors whether they occur as part of anorexia, bulimia or binge eating (or any form of disordered eating that doesn’t fall neatly into one category). People are often surprised to learn that we use the same treatment to address what seems like totally different conditions. The reality is that anorexia, bulimia, and binge eating disorder share many of the same core features. One common core feature across diagnoses is an extreme concern with weight and shape. This overvaluation of shape and weight is known to trigger behaviors like food restriction, binge eating and purging.
If learning more about CBT-E leaves you interested in exploring the treatment with a skilled provider, here are a few tips for finding the right person to guide your CBT-E journey:
- Enhanced CBT is different from standard CBT. It’s important to ask potential providers about their training and to be sure that their training is in CBT-E, specifically. There’s not a CBT-E “certification” per se; most CBT-E providers have been trained in practice, research or academic settings. The Centre for Research on Dissemination at Oxford (CREDO) provides online training for professionals, which is an excellent way to learn CBT-E.
- Adherence to the CBT-E treatment as it’s intended increases the potential for a good outcome. Integrating “some CBT-E techniques” is generally not enough and may result in a diluted treatment. It’s like taking a medication that’s been watered down; it just won’t work as well.
- A CBT-E therapist will explain at the start of treatment that the work will be time-limited (about 20 weeks for bulimia and binge eating and 40 weeks for anorexia). There will be four distinct stages and a clear agenda for each and every session. Issues unrelated to eating will not be the focus of treatment and should be tabled until after CBT-E is completed. If the provider is inclined to approach the treatment as open-ended or with a loose structure and time frame, then it’s not CBT-E.
- Involved treatments “programs” with lots of groups and additional services are not always necessary. CBT-E is intended to be the intervention.
Of note, CBT-E is not typically the first-line approach for children and teens with anorexia or bulimia. Most often, treatment for kids/teens with eating disorders need to incorporate caregivers, either as central to the treatment or closely integrated. Family-Based Treatment is a more common recommendation for younger people presenting with disordered eating.
Barriers to Accessing CBT-E for Eating Disorders
Unfortunately, therapy can be very expensive and thus not accessible to most people who need it. It may be difficult to find adherent CBT-E providers who accept commercial insurance or Medicaid. Of note, there is a self-guided version of CBT-E: Overcoming Binge Eating by Christopher Fairburn. This self-help guide can be an effective course for binge eating disorder and for some cases of bulimia. It may be more effective if there is external support available as a supplement.
Some specialized eating disorder research and training centers offer CBT-E for reduced fees or even free of charge in exchange for participation in research studies. It may take some searching online to identify local facilities or institutes with research protocols and the opportunity for free treatment.
If you or a loved one is struggling with an eating disorder, please reach out to our team at email@example.com to discuss treatment options.